| Objectives: This study was aimed to analysis the effects of recombinant human brain natriuretic peptide(rh-BNP)on myocardial electrical activity in patients with heat failure and its prevention and treatment of arrhythmia by observing the rh-BNP effects N-terminal probrain natriuretic peptide(NT-proBNP)in patients with heat failure,Q-T duration dispersion(QTd)P-wave dispersion(Pd),duration of QRS complex,heart rate ariability(HRV),and Heart rate turbulence(HRT).Methods:Enrolled from March 2015 to December 2016 admitted to cardiology department of Bethune international peace hospital consecutive 82 cases in accordance with New York heart association(NYHA)diagnostic criteria of cardiac function grade II-IV level in patients with heart failure,including 38 cases of male and 44 cases of female.Eligible patients were randomly divided into two groups,the rh-BNP group(total 42 cases,male 20 cases and female22 cases,average age 68.7±7.8 years),and the control group(total 40 cases,male 18 cases and female 22 cases,average age 68.7±7.8 years).Exclusion criteria:(1)Cardiac shock,insufficient blood volume or any other taboo to give vasodilator;(2)Severe hepatic insufficiency or severe renal insufficiency;(3)Obvious valvular stenosis hypertrophic or restrictive cardiomyopathy,constrictive pericarditis,myocarditis,or patients with severe pulmonary hypertension;(4)But not feasible radical surgical radical in patients with congenital heart disease;(5)With other system serious diseases such as malignant tumor,hemorrhagic disease,hyperthyroidism,autoimmune diseases;(6)Recording ECG on electrolyte disorder,ectopic rhythm of the heart;(7)Install cardiac pacemaker,implanted ICD or use impact Q-T duration dispersion drugs;(8)Allergic to rh-BNP.All the patients admitted to hospital immediately precursor determination of NT-proBNP,blood routine,electrolytes,and renal function,within 24 hours after admission improve blood lipids,blood glucose,liver function,and respectively before and after1 week treatment performed by the same person 12-lead ectrocardiogram,within 48 hours after admission and 3 months after treatment,respectively complete echocardiography,48 hours after admission and 1 month after treatment respectively complete 24 hour ambulatory electrocardiogram.Records of patients with clinical data,including gender,age,on admission and treatment of blood pressure,heart rate,complications,hypertension,arrhythmia,diabetes,chronic obstructive pulmonary disease,severe liver malfunction,severe renal insufficiency,hyperlipidemia,cardiac functional grading,left atrial diameter,left ventricular diameter and left ventricular ejection fraction(LVEF).All the patients were performed after admission oxygen therapy,diuretic and vasodilator,beta blockers,antiplatelet,angiotensin converting enzyme inhibitors(ACEI)or angiotensin II receptor blockers(ARB)and other basic treatment,according to patients condition give appropriate symptomatic treatment.Control group given conventional treatment,rh-BNP group on the basis of conventional treatment dose recombinant human brain natriuretic peptide load for 1.5μg/kg intravenous injection,according to the hemodynamic parameters by 0.0075-0.020μg/kg/min continuous intravenous pumping 3 to 7 days.two groups of patients with systolic blood pressure not below 90 mmHg during treatment.Record two group of patients,clinical medicine and laboratory tests,comparison between the two groups after treatment P-wave dispersion,Q-T duration dispersion,QRS complex duration,NT-proBNP changes,record and compare the two groups of patients after 1 month index of heart rate turbulence,heart rate variability,and after 3 months left ventricular ejection fraction,at the same time,the two groups were compared before and after treatment in the change of the index.SPSS 21.0 was used for analyzing data,and P<0.05 was considered statistically significant.Results:1 Comparison about baseline clinical characteristics:A total of 82 patien-ts were enrolled,with 42 case in rh-BNP group,and 40 cases in control group.There were no significant differences between both group in baseline characteristics,including age,gender,weight,blood pressure,heat rate,cardiac functional grading,Primary heart failure,history of hypertension,chronic obstructive pulmonary disease,diabetes,chronic renal,disease baseline laboratory tests(Including blood potassium,sodium,liver function,renal function,blood lipid)and basic drugs(including aspirin,diuretics,vasodilators,beta blockers,ACEI/ARB)were no statistical difference(all P>0.05).2 Comparison about NT-proBNP before and after treatment: There was no significant difference between the rh-BNP group and the control group before treatment with NT-proBNP(P=0.903),rh-BNP group and control group NT-proBNP was decreased,the rh-BNP group of patients with NT-proBNP decrease more than control group,the difference was statistically significant(3736.52±1245.74pg/ml vs.4753.95± 1876.01 pg/ml,P=0.005).3 Comparison about P-wave dispersion before and after treatment:There was no significant difference between the rh-BNP group and the control group before treatment with Pmax and Pd(P=0.784;P=0.728),rh-BNP group and control group Pmax and Pd were decreased,the rh-BNP group of patients with Pmax and Pd decrease more than control group,but the difference was no statistically significant(93.32±12.61 ms vs.94.98±9.55 ms,P=0.506;41.45±7.59 ms vs.41.70±10.04 ms,P = 0.900).4 Comparison about Q-T duration dispersion before and after treatment:There was no significant difference between the rh-BNP group and the control group before treatment with QTd and QTcd(P=0.720;P=0.843),rh-BNP group and control group QTd and QTcd were decreased,the rh-BNP group of patients with QTd and QTcd decrease more than control group,the difference was statistically significant(48.12±13.55 ms vs.53.94±11.70 ms,P=0.041;53.71±13.26 ms vs.59.84±12.42 ms,P=0.034).5 Comparison about QRS complex before and after treatment:There was no significant difference between the rh-BNP group and the control groupbefore treatment with QRS complex(P=0.110),rh-BNP group and control group QRS complex was decreased evidently,the rh-BNP group of patients with all indexes decrease more than control group,but the difference was no statistically significant(106.45±12.51 ms vs.108.27±15.01 ms,P=0.551).6 Comparison about heart rate variability before and after treatment:There was no significant difference between the rh-BNP group and the control group before treatment with SDNN、SDANN、RMSSD and PNN50(P=0.396;P=0.740;P=0.626;P=0.756),rh-BNP group and control group after 1 months all indexes were increased,the rh-BNP group of patients with all indexes increase more than control group,SDNN(116.10±11.83 ms vs.108.50±11.40 ms,P=0.012)、SDANN(72.00±12.95 ms vs.65.78±10.74 ms,P=0.036);RMSSD(27.83±4.32 ms vs.25.03±3.30 ms,P=0.005);PNN50(11.07±2.45 ms vs.9.91±1.71 ms,P=0.034),the difference was statistically significant.7 Comparison about heart rate variability before and after treatment:There was no significant difference between the rh-BNP group and the control group before treatment with TO and TS(P=0.316,P=0.890),rh-BNP group and control group after 1 months TO was decreased,the rh-BNP group of patients with TO decrease more than control group,but the difference was no statistically significant(0.67±0.35% vs.0.77±0.44%,P=0.331).Two groups after 1 months TS was improved,the rh-BNP group of patients with TS increase more than control group,but the differences was no statistically significant(2.39±0.26mm/RR vs.2.32±0.24 mm/RR,P=0.273).8 Comparison about ultrasound cardiogram before and after treatment:Rh-BNP group and control group before treatment LVEF level no statistical difference(P=0.0.290),Rh-BNP group and control group after 3 months LVEF was improved,the rh-BNP group of patients with LVEF increase more than control group,3 months after the LVEF difference between the two groups was statistically significant(48.59±3.83% vs.46.33 ±4.11%,P=0.013).9 The comparison of the cardiac arrhythmia after treatment: Rh-BNP group of patients with malignant arrhythmia in 3 cases,control group ofpatients with malignant arrhythmia in 10 cases.The incidence of arrhythmia of between the two groups was statistically significant(7.1% vs.22.5%,P=0.035).10 Sudden death: Rh-BNP group of patients with sudden death in 1cause,death for ventricular fibrillation,control group patients with sudden death in 1 case,death for ventricular fibrillation.Conclusion:1 Intravenous application of rh-BNP can significantly reduce the NT-proBNP levels and Q-T duration dispersion in patients with heart failure,and improve heart rate variability index.2 Patients with heart failure should be intravenous application of rh-BNP as soon as possible,it can better improve the myocardial electrical activity in patients with heart failure,reduce the rate of arrhythmia,improve heart failure symptoms and prognosis. |
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